Provider Demographics
NPI:1043269509
Name:FRAZIER, LAURI ELIZABETH (OD)
Entity Type:Individual
Prefix:
First Name:LAURI
Middle Name:ELIZABETH
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 FRANKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36350-6034
Mailing Address - Country:US
Mailing Address - Phone:334-873-4247
Mailing Address - Fax:
Practice Address - Street 1:1892 ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360-3724
Practice Address - Country:US
Practice Address - Phone:334-774-4703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-B17-TA-702152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
051557859Medicare PIN